Exercise and Work-Oriented Back Pain Management Programs

Low back pain affects many working adults. Exercise interventions such as graded activity programs can involve specific exercises for increasing flexibility and strengthening back muscles, or exercises to improve overall strength and fitness. Physical conditioning programs, also called work conditioning, work hardening, or functional restoration/exercise programs, are generally designed by physical therapists.

Expected Beneficial Outcomes: Reduced absenteeism. Other Potential Beneficial Outcomes: Reduced pain.

Evidence of Effectiveness: There is some evidence that exercise programs targeting lower back pain (LBP), especially in the workplace, reduce sickness absence and promote return to work. Additional evidence is needed to confirm effects. Exercise programs can increase the likelihood that patients on work disability due to non-acute LBP return to work. Graded activity exercise programs in the workplace can reduce sick leave usage among employees suffering from sub-acute LBP, and may increase the likelihood that individuals with chronic LBP return to work. Intense physical conditioning programs (six or more sessions) may reduce sickness absence due to chronic back pain, and have also been shown to be effective for sub-acute pain when an explicit workplace component is included. Light conditioning programs (five sessions or fewer) appear to have no effect on sub-acute or chronic LBP, and there is no evidence light or intense physical conditioning programs reduce sick leave duration for acute LBP. Simple exercise programs appear to have similar effects to complex exercise programs for workers at work; for workers off work due to sub-acute LBP, some complex exercise programs may be more effective. Exercise therapy can reduce the severity of back pain and related physical disability. Exercise programs focused on building strength with resistance training or increasing coordination and stability appear to be more effective at reducing chronic LBP than other exercise interventions. Exercise, alone or combined with education, appears to reduce the risk of LBP.